Abstract
PurposeTo revisit the concept of spondylotic traumatic central cord syndrome (TCCS) by assessing the frequency of discoligamentous injury and to correlate magnetic resonance imaging (MRI) and intraoperative findings.MethodsA retrospective analysis of twenty-three consecutive patients (mean age: 62.7 ± 14.8 years) with profound spondylotic TCCS after acute cervical hyperextension trauma but without signs of instability on initial CT scans who underwent anterior surgical decompression and fusion was performed. Sensitivity and specificity of MRI in the detection of anterior longitudinal ligament disruption were calculated. The topographic relations between surgically verified segmental instabilities and spinal cord signals on MRI were analyzed. The cervical MRI scans of all patients were evaluated by the radiologist on call at time of admission, re-assessed by a specialized MRI radiologist for the purpose of this study and compared with intraoperative findings.ResultsIntraoperative findings revealed 25 cervical spine segments with hyperextension instability in 22 of 23 (95.7%) patients. The radiologist on call correctly assessed segmental hyperextension instability in 15 of 25 segments (sensitivity: 0.60, specificity: 1.00), while the specialized MRI radiologist was correct in 22 segments (sensitivity: 0.88, specificity: 1.00). In 17 of 23 (73.9%) patients, the level of spinal cord signal on MRI matched the level of surgically verified segmental instability.ConclusionsOur findings challenge the traditional concept of spondylotic TCCS as an incomplete cervical spinal cord injury without discoligamentous injury and emphasize the importance of MRI as well as the radiologist’s level of experience for the assessment of segmental instability in these patients.Graphical abstractThese slides can be retrieved under Electronic Supplementary Material.
Highlights
Traumatic central cord syndrome (TCCS) is the most frequent type of incomplete cervical spinal cord injury [1,2,3]
Inclusion criteria were: (1) history of an acute trauma of the cervical spine; (2) traumatic central cord syndrome (TCCS) at admission; (3) availability of both computed tomography (CT) and magnetic resonance imaging (MRI) scans obtained at admission; (4) no evidence of fractures or signs of instability on the initial CT scan; (5) hyperintense spinal cord signal on T2-weighted and short tau inversion recovery (STIR) MRI scans; and (6) spinal cord decompression via ACDF within one week after trauma
The center of the hyperintense spinal cord signal as assessed by MRI was located at C3/4 in 8 patients (34.8%), at C4/5 in 2 patients (8.7%), at C5/6 in 11 patients (47.8%), and at C6/7 in 2 patients (8.7%)
Summary
Traumatic central cord syndrome (TCCS) is the most frequent type of incomplete cervical spinal cord injury [1,2,3]. An expert consensus paper recommends early decompression in patients with profound neurological impairment (American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade C or worse) and initial observation in patients with less severe neurological impairment with optional surgery at a later date [7]. These recommendations, are based on the assumption of a stable spondylotic cervical spine without acute discoligamentous injury [3]
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